Cardiovascular Disease: Risk Factors

A risk factor is something that increases your likelihood of developing a disease or condition. It is certainly possible to develop cardiovascular disease (CVD) without risk factors, but having risk factors makes it more likely. Some risk factors for CVD are not modifiable, but many are. Being aware of your risk factors and taking steps to reduce them can slow or even arrest the progression of CVD at multiple points:

Before atherosclerosis leads to a cardiovascular event, such as a heart attack

After the first, but before any subsequent cardiovascular events

Non-modifiable risk factors are those that you cannot change. It is still a good idea to be aware of these factors to get a sense of your risk.

Age—For men, age 45 or older; for women, age 55 or older.

Race—African Americans have a greater incidence of hypertension than Caucasians, and therefore a higher risk of developing CVD. Others at increased risk include Mexican Americans, Native Americans, native Hawaiians, and some Asian Americans.

Gender—Men tend to suffer cardiovascular events sooner than women. After menopause, however, cardiovascular risk in women quickly catches up to that in men.

Modifiable risk factors can be reduced or eliminated through lifestyle changes, medical treatment, or a combination of both. Many of these risk factors are interrelated, and attending to one can often have beneficial effects on others.

Smoking—Smokers are twice as likely to have a heart attack as nonsmokers. Cigarette smoking is also the biggest risk factor for sudden cardiac death. Even nonsmokers can increase their risk of heart disease if they are constantly exposed to cigarette smoke.

High blood cholesterol—High total and low-denisty lipoprotein (LDL) cholesterol levels and low high-density lipoprotein (HDL) cholesterol levels increase the risk of atherosclerosis, coronary heart disease, and stroke. In general, a total cholesterol level less than 200 mg/dL (5.2 mmol/L) , an LDL cholesterol level less than 100 mg/dL (2.6 mmol/L), and an HDL cholesterol level greater than 60 mg/dL (1.6 mmol/L) are considered desirable.

High blood pressure—High blood pressure accelerates the progression of atherosclerosis and increases the risk of coronary artery disease (CAD), stroke, and heart failure. High blood pressure is defined as a blood pressure equal to or above 140/90 mmHg. However, individuals with blood pressure in the high-normal range (around 130/85 mmHg) are at increased risk of becoming hypertensive and should take steps to lower their blood pressure.
Check with your doctor to see about your target range.

Obesity
and overweight—
Excess body fat, particularly in the abdominal region, is associated with an increased risk for heart disease and stroke. Surplus weight puts additional strain on your heart, and raises blood pressure, blood cholesterol and the risk of type 2 diabetes.

Type 2 Diabetesand prediabetes—Type 2 diabetes is a major risk factor for CVD. About two-thirds of people with diabetes die of some type of heart or blood vessel disease. Glucose intolerance prior to the onset of type 2 diabetes can also place you at increased risk.

Excess alcohol—Drinking too much alcohol can raise your blood pressure, cause heart failure, and lead to stroke. It can contribute to high triglycerides (fats in the blood), obesity, and arrhythmias.

Stress
—Although it remains unclear exactly how much psychological stress contributes to the development of CVD, if you have already been diagnosed with a cardiovascular condition, you could benefit from stress management.

Emerging risk factors—
The association of these risk factors with CVD is less well established, but many authorities believe they will become clinically important in the near future.

C-reactive protein—C-reactive protein is a marker of inflammation. High levels of the protein have been associated with increased risk of heart disease and stroke, even when total and LDL-cholesterol levels are low. It is not yet known how to reduce C-reactive proteins.

Homocysteine—Homocysteine is an amino acid (building block of protein) that appears to contribute to atherosclerosis and blood clotting. High levels of homocysteine have been linked to increased risk of heart disease. Folic acid in the diet is effective at reducing homocysteine levels.

The purpose of screening for CVD is to detect it and treat it prior to the onset of symptoms. Screening involves the medical history, physical examination, and certain tests designed to assess both your risk for CVD and any evidence that already exists.

Medical History—You physician will ask you questions about current and previous illnesses, past surgeries and hospitalizations, medications, diet and other lifestyle factors, social history, and family history in order to gauge your CVD risk.

Physical Exam—Your doctor may assess the following:

Body Mass Index—(BMI) is a measurement of body mass that takes into account both height and weight.

Fat Distribution—This is usually measured as a waist-to-hip ratio. Carrying more fat around your abdomen and upper body (an “apple” shape) puts you at greater risk for heart disease, high blood pressure, and diabetes.

Blood Pressure Measurement—Blood pressure is measured using a cuff around your arm and a device called a sphygmomanometer. Blood pressure has a tendency to fluctuate and needs to be measured several times before a diagnosis of hypertension can be made.

Blood Tests—For the following tests, blood may be drawn in your doctor’s office or in a laboratory. The blood is then sent to the laboratory for analysis, and you should receive the results within one week.

Lipid Profile—
A complete lipid profile will measure the levels of total cholesterol, LDL and HDL cholesterol, and triglycerides in your blood.

Blood Sugar/Glycohemoglobin (HBA1C)—These tests are used to both screen for diabetes and monitor the progress of diabetes treatment.

Exercise Tolerance or Stress Test—Using an electrocardiogram (EKG) to measure the heart’s electrical activity at rest provides limited information about the oxygen supply to the heart. A stress test, therefore, is often used to evaluate the presence and severity of cardiovascular disorders as the heart responds to the additional demand for oxygen during physical activity.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Who is at risk for coronary heart disease? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/atrisk. Updated September 29, 2014. Accessed September 23, 2015.